Doctor's First Report of Occupational Injury or Illness - Form 5021

Within 5 working days of an injured worker’s initial examination, the Primary Treating Physician shall submit a Doctor's First Report of Occupational Injury or Illness - Form 5021 to the claims administrator.

Primary treating physician's progress report - DWC PR-2

Under certain conditions, a Primary Treating Physician must issue a PR-2 report to a claims administrator

Primary treating physician's permanent and stationary report - DWC PR-3

For injuries which occurred prior to 2005, when the primary treating physician determines that the employee's condition is permanent and stationary, the physician shall report within 20 days from the date of examination any findings concerning the existence and extent of permanent impairment and limitations and any need for continuing and/or future medical care resulting from the injury. The information may be submitted on the "Primary Treating Physician's Permanent and Stationary Report" form (DWC Form PR-3).

Primary treating physician's permanent and stationary report - DWC PR-4

For injuries which occurred on or after January 1, 2005, when the primary treating physician determines that the employee's condition is permanent and stationary, the physician shall report within 20 days from the date of examination any findings concerning the existence and extent of permanent impairment and limitations and any need for continuing and/or future medical care resulting from the injury. The information may be submitted on the "Primary Treating Physician's Permanent and Stationary Report" form (DWC Form PR-4).

DWC Lien Form

The California Division of Workers’ Compensation (DWC), along with the Workers’ Compensation Appeals Board (WCAB), has released an amended lien form including the new declaration requirements set forth by Labor Code Section 4903.05(c). All liens filed after January 1, 2017, must use this form.

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